Your browser does not support the NLM PubReader view.

Go to this page to see a list of supporting browsers.

Homonymous hemianopia in a patient with Behcet's disease

Article information

Korean J Intern Med. 2015;30(3):418-419
Publication date (electronic) : 2015 April 29
doi : https://doi.org/10.3904/kjim.2015.30.3.418
Won-Seok Lee, Mi-Hee Kang, Won-Sik Jung, Yun-Hong Cheon, Wan-Hee Yoo
Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University Hospital, Jeonju, Korea.
Correspondence to Wan-Hee Yoo, M.D. Tel: +82-63-250-1672, Fax: +82-63-254-1609, ywhim@jbnu.ac.kr
Received 2014 October 13; Revised 2014 October 24; Accepted 2014 November 04.

A 49-year-old male with a 10-year history of Behcet's disease (BD) presented with sudden visual field defects in both eyes the first occurred when walking. Laboratory testing revealed an elevated serum C-reactive protein (1.3 mg/dL) and erythrocyte sedimentation rate (47 mm/hr). The Humphrey visual field test showed right homonymous hemianopia (Fig. 1), while no abnormal findings were identified on fundal examination. Suspecting homonymous hemianopia, magnetic resonance imaging (MRI) was performed; T2 fluid-attenuated inversion recovery MRI showed circumferential high-intensity lesions of the left lateral geniculate body (Fig. 2A). Consequently, he was diagnosed with acute neuro-BD and given steroid pulse therapy (1 g/day) for 3 days, followed by highdose prednisolone (1 mg/kg/day) and a cyclophosphamide pulse (750 mg/day). The lesions in the lateral geniculate body were reduced on MRI taken 2 weeks after treatment (Fig. 2B), but the homonymous hemianopia remained nearly unchanged. We plan to administer two cyclophosphamide pulse treatments per month. Ocular manifestations are one of the main features of BD, especially uveitis and retinal vasculitis that progressively damage the vision. Homonymous hemianopia with hemianopic visual field loss on the same side in both eyes is extremely rare in BD. The pathogenesis of the lesions in the geniculate bodies in these cases is believed to be related to underlying vascular involvement of the inflammation. Early immunosuppressant use is necessary; intravenous cyclophosphamide combined with corticosteroids can improve the prognosis. When patients with BD have visual defects, clinicians should consider brain MRI to detect cerebral lesions, as well as a fundal examination.

Figure 1

Humphrey visual field testing showed the loss of half of the field of view on the right side in both eyes; i.e., right homonymous hemianopia.

Figure 2

(A) T2 fluid-attenuated inversion recovery magnetic resonance imaging (MRI) showed circumferential high-intensity lesions in the left lateral geniculate body. (B) These lesions were reduced in MRI images taken 2 weeks after treatment.

Notes

Conflict of interest: No potential conflict of interest relevant to this article was reported.

Article information Continued

Copyright © 2015 The Korean Association of Internal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figure 1

Figure 1

Humphrey visual field testing showed the loss of half of the field of view on the right side in both eyes; i.e., right homonymous hemianopia.

Figure 2

Figure 2

(A) T2 fluid-attenuated inversion recovery magnetic resonance imaging (MRI) showed circumferential high-intensity lesions in the left lateral geniculate body. (B) These lesions were reduced in MRI images taken 2 weeks after treatment.